Hair regrowth using a properly fitted scalp cooling cap during adjuvant chemotherapy for breast cancer

Abstract

Patients with breast cancer desire to avoid chemotherapy-induced alopecia because it induces mental stress during treatment. Scalp cooling can suppress chemotherapy-induced alopecia without increasing the risk of scalp metastasis; however, in certain cases, alopecia cannot be prevented. The use of properly fitted scalp cooling caps has not yet been explored in Asian patients. Here, we report a case of hair regrowth using a properly fitted scalp cooling cap during adjuvant chemotherapy for breast cancer. A 51-year-old Japanese woman who was recalled by screening mammography for grouped amorphous calcifications and architectural distortion visited our hospital. Preoperative diagnosis was cT2N0M0 cStage IIA. Sentinel lymph node biopsy revealed axillary metastasis; hence, left mastectomy and axillary lymph node resection were performed. Pathological diagnosis revealed ER/PgR-positive and HER2-negative invasive lobular carcinoma (pT3N2M0 pStage IIIA). Adjuvant chemotherapy comprising four cycles of docetaxel every 3 weeks as well as four cycles of FEC every 3 weeks was performed with scalp cooling. After the first cycle of docetaxel, a 10-cm oval hair loss patch was observed at the vertex of the patient's head. Assuming the scalp cooling cap was not efficiently in contact with the vertex of the patient's head, we modified and properly fit the scalp cooling cap. After the third cycle of docetaxel, hair regrowth at the vertex began and gradually increased during chemotherapy. The patient did not require hair wigs during and after adjuvant chemotherapy. The scalp cooling cap should be carefully fitted at the vertex of the head, which is difficult to be covered, particularly in the case of Japanese patients. In addition, further development of properly fitted scalp cooling caps suitable for various individuals is necessary.

Scalp Cooling Impact in Alopecia of Patients Under Treatment for Breast Cancer—Literature Review

“…Hair loss was observed in the second cycle of docetaxel, but hair growth was displayed in the third cycle, which was improved with cooling cap procedure without any hazardous effects on the patients. The authors also report that patients' ethnic characteristics may interfere with the effectiveness of cooling, since Asian women are more susceptible to the toxic effects of chemotherapy than European women, for example [7].…”

“…Regarding chemotherapy protocols, the most used are the FEC (fluorouracil/epirubicin/cyclophosphamide), AC (doxorubicin/cyclophosphamide), EC (epirubicin/cyclophosphamide), TC (docetaxel/cyclophosphamide), paclitaxel (P), docetaxel (D), TAC (docetaxel/doxrubicin/cyclophosphamide), among others [5][6][7][8]. In addition, monoclonal antibodies, such as trastuzumab and pertuzumab, have also shown results in the neoadjuvant and adjuvant treatments of patients with HER-2 positive breast cancer [9,10].…”